Thank you for your recent inquiry.
I think that you have already done due diligence in your evaluation of this patient. From your description, it appears that he is having recurrent episodes of angioedema of the uvula. As you know, the vast majority of episodes of angioedema are idiopathic, and based upon your workup, I think that you have already looked at all potential causes of angioedema in this patient.
Unfortunately, with episodes of recurrent angioedema, quite often there is very little that we can offer a patient to prevent them. However, in most instances, these episodes will subside over time.
The only further suggestion that I might have is that in patients who have an excessively long uvula, a modest amount of swelling is quite uncomfortable and on occasion, in patients with recurrent angioedema of the uvula, we have been able to improve the patient's quality of life by performing a partial uvulectomy. Therefore you might consider this if the episodes continue, and he does have an excessively long uvula.
There is a nice review of this problem which is available in its entirety online without charge. The abstract of this review is copied below.
Thank you again for your inquiry and we hope this response is helpful to you.
Emergency Medicine News:
July 2001 - Volume 23 - Issue 7 - p 7-12
Acute Angioedema of the Uvula
Roberts, James R. MD
Acute angioedema isolated to the uvula is a frustrating and confusing condition that most emergency physicians see a few times a year. Spontaneous swelling of the uvula is actually quite common, its etiology is usually obscure, and it's unclear whether any treatment alters the clinical course. Most cases are mild and annoying but rather inscrutable.
Phil Lieberman, M.D.